US primary care spending continues on downward trend

Primary care spending made up only 4.67% of total national commercial health care spending in the United States in 2019, down from 4.88% in 2017, a recent report showed.

“Primary care spending remains low and is trending lower,” Ann Kempski, MILR, an advisor for the Primary Care Collaborative (PCC) and lead author of the report, said during a media briefing. “The primary care workforce indicators are mixed positive, but overall, are not the kind of progress towards primary care that we had hoped for.”

Kempski said the findings support other recent reports, including a study published in December 2019 that indicated primary care spending was dropping across different categories of spending.

The new PCC report applied both narrow and broad definitions of primary care spending across commercial payers to its analysis. The narrow definition applied to services provided by family and internal medicine, pediatric and general practice physicians in offices and outpatient settings. The broad definition included everything within the narrow definition and added adolescent medicine specialists, geriatricians, gynecologists, nurse practitioners and physician assistants.

Overall, the report showed that primary care spending per capita fell 3.78% from 2017 to 2019.

There is some good news, according to Kempski. She said before COVID-19 was declared a national emergency, some individual states’ primary care spending from commercial payers was better than the national average. The report highlighted positive efforts in some states, including:

• In Michigan, the “dominant” insurance carrier in the state’s commercial markets and large employers were actively engaged in purchasing health care. The PCC said this is likely the reason primary care spending made up 9.48% of the state’s narrow health care spending and 13.86% of its broad health care spending in 2019.
• In Oregon, commercial insurance carriers and Medicaid Coordinated Care Organizations must allocate 12% of their health care spending to primary care by 2023. In 2019, primary care spending made up 8.07% of the state’s narrow health care spending and 15.35% of its broad health care spending.
• Pennsylvania recently established an Interagency Health Reform Council that, according to the PCC, will conduct evaluations of “health care payment and delivery systems to provide efficient, whole-person health care that also contains costs, reduces disparities and achieves better health outcomes.” Though primary care spending made up only 3.37% of the state’s narrow health care spending and 5.57% of its broad health care spending in 2019, the PCC said the council’s creation signifies the state’s future commitment to investing in primary care.

Kate Goodrich, MD, senior vice president of trends and analytics at Humana and a former chief medical officer at CMS, said the pandemic could put even the best-laid spending plans into a tailspin.

“The pandemic caused a tsunami of health care needs,” she said. “The impact of delayed or avoided care is going to be substantial and very challenging to meet, particularly for practices that have lost so much revenue. I won't pretend I have a solution for it, but we must be prepared for it.”

The PCC’s full report is available here.